What is Hyperacusis?

As someone living with hyperacusis, I’m vulnerable to seeing the condition through my own lens. So let’s start with the way The Hearing Health Foundation defines hyperacusis:

📖 Hyperacusis is a debilitating disorder of sound tolerance, where even ordinary, everyday sounds are perceived as abnormally loud and sometimes excruciatingly painful. In some ways, it’s the opposite of hearing loss. The volume of the world is turned up, not down. The Hearing Health Foundation

When I first started grappling with hyperacusis, a specialist explained that I was showing signs of what doctors call “loudness hyperacusis” and “pain hyperacusis.” He also warned me that patients often progress to experience more forms of hyperacusis, including what they call “annoyance hyperacusis” and “fear hyperacusis.” Understanding the differences, he urged, could help me engage and improve my symptoms.

That doctor offered me a map of the world that opened up possibilities to make choices. I have used this understanding of the four kinds of hyperacusis to help my condition not worsen while I worked to improve my functioning. If you or someone you care about is struggling with the sounds around them, you’re not alone.

4 Kinds of Hyperacusis

As you can see from this diagram, the other three forms of hyperacusis overlap with loudness hyperacusis. Let’s start there.

Loudness Hyperacusis

Loudness hyperacusis is like a form of super hearing where even moderate sounds are experienced as too loud, causing discomfort, disorientation, and often an exaggerated startle response. 

Though hyperacusis is more common in children, I was in my thirties when it started for me. I went from being a loud-talking, music-blaring person to struggling to handle sounds at 40 decibels.

🧐 How loud is 40 decibels? Unless you’re consciously lowering your voice, most conversations take place at 70 decibels and above. A whispered conversation with one person in a quiet environment was the loudest loud I could tolerate when my symptoms began.

That sense of things feeling “too loud” can leave you feeling chased by sound, afraid and angry. That’s where annoyance and fear come in. But before we move on to those types of hyperacusis, notice that while sometimes the annoyance bubble overlaps with loudness…sometimes it doesn’t. Sometimes, annoyance can exist even when sounds aren’t too loud.

For me, living with hyperacusis, I went through an intense phase of working to untangle my annoyance from the certainty that sounds were too loud. Sometimes the sound was just irritating, like fingertips grazing over a bandaged wound. Not harmful, no lasting impact. Desirable? No. But not all irritating sounds needed to be removed from my life in order to heal. In fact, there’s magic in the pool of irritating-but-not-too-loud sounds. These were the sounds that could help me gradually reduce my sound sensitivity. But more on that later.

Pain Hyperacusis

Pain hyperacusis seems to be the product of some form of synesthesia. It’s as if the neurons involved in pain conduction get confused with those handling auditory processing. For me, a level of painfulness accompanied all sounds, even quiet ones. That’s why my first audiologist said I exhibited loudness and pain hyperacusis. Sometimes, I’d have stabbing or jabbing pains, especially with any sound more than 20 decibels above my tolerance threshhold. Other people with pain hyperacusis talk about hot poker, jabbing, or even burning sensations. By far, this is the kind of hyperacusis most associated with disability.

At the beginning for me, the pain was a constant feature of my symptoms. And the pain didn’t go away during silence. Like many people with hyperacusis, I also experienced severe tinnitus. That meant even in silent environments, a roar of noise and riot of tones were sounding in my ears from the inside.

Now more than three years after my symptoms started, pain hyperacusis is no longer constant. If you’re suffering constant pain symptoms now, please know that this part can actually get much better, sometimes resolving completely (and I’m not the only person who says so!).

Annoyance Hyperacusis

Annoyance hyperacusis often develops with prolonged experience of loudness hyperacusis, exhibited by adverse emotional reactions to sounds. Dread, anxiety, and irritability can quickly develop when the world around you feels too loud. That meant that with my loudness hyperacusis, I needed to engage and care for my emotional health, address my emotional responses to sounds, and be aware of them so that I didn’t develop ingrained emotional patterns that would be hard to unravel. 

Fear Hyperacusis

Fear hyperacusis seems to be a kind of hyperacusis that could affect me even in the absence of sounds, generating fear and avoidance of sounds because of my negative associations. A helpful doctor helped me understand that my condition left me vulnerable to fear and withdrawal.

🌋 Unaddressed pain and unprocessed emotions turn into fear and self-defeating choices for everyone.

Whether we’re dealing with neurological, genetic, situational, or interpersonal challenges, we can be tempted to stew in our emotions, to snooze the early warning bells that something is wrong. But when we do that, we often abdicate our opportunity to make an intentional choice, surrendering to the overwhelm, mania, panic, or despair that develops in the crock pot of un-dealt-with feelings.

💭 The chance to change an attitude, improve well-being, and to gain perspective is never guaranteed. So when we have them, we need to let the gentle tug of awareness break our inertia and make the choice today that may not come again tomorrow. Make the Choice You Can

Living With Hyperacusis

In the context of my hyperacusis, that helpful doctor who reminded me there were four types of hyperacusis nudged me to participate in whatever small ways I could to reduce progress from loudness and pain into annoyance and fear. I didn’t have control of my body’s sudden shift in auditory processing, but I could take steps to shovel the emotional snowfall while it came down rather than waiting until I was snowed in, trapped in an escalated neurological state harder to dig out later.

I’ve lived for several years, experiencing all four kinds of hyperacusis for long periods of time. I’ve also experienced reduction in severity and relief from some forms of hyperacusis.

I took a few steps that seem to have helped me improve my experience. Here they are in case you want to experiment for yourself:

1. Embrace Irritation By learning to notice where fear and annoyance existed without loudness, I found healthy places to challenge my fear and release my annoyance. Breathing through the annoyance, practicing gratitude, or even just delaying before withdrawing from annoying sounds slowly reduced the level of irritation those sounds caused me. I would go to the library (a generally quiet-ish environment), and when an irritating but not damaging noise (like a conversation or frequent click of a neighbor’s mouse) started up, I would breathe and smile and remain in place, letting it pass over and through me. When I started, I could delay removing myself (or inserting noise blockers) only 15 seconds. Then up to 60 seconds. Now I can sit at the library and write or read without noticing the non-damaging level sounds around me. By letting the irritation slowly chip at me, I now have a level of peace restored.
2. Unravel Fear Fear also can exist where no loudness hyperacusis overlaps. These are the situations where dread of painful sounds would cause me heightened sensitivity…even without any problem being manifest. I could sit in a silent home, dreading the arrival of the landscaping crew, powerless to change the neighborhood-wide lawn care routine. But over time I had to learn that not all of the things I was afraid of could actually hurt me. I don’t often quote Dune, but “Fear is the mind killer.” I started using a decibel checker to recognize if a sound that I was afraid of was actually loud enough to hurt me, or if it was in my tolerance range. Using data to fight fear was effective as I fought my way back toward engaging in life.
3. Feel Pain Without Fear (or Annoyance) One last important truth that diagram of types of hyperacusis shows is that pain can exist without fear or annoyance. This diagram also shows that the pain isn’t an illusion—it exists because sounds are too loud, or at least too loud when synesthesia confuses auditory and pain conduction messages. I am always allowed and encouraged to do something constructive to respond to the pain. But hands down, pain does not inevitably lead to fear. It does not always travel with irritation. I spent plenty of days huddled in the couch corner, pained, afraid, and raw with sensory irritation. But dead center of this diagram is no place to live. I read an awesome book by Karra Eloff called The Chronic Pain Couple that inspired me to think differently about not waiting for pain to end before moving on into a wild and brave life.

💭 Avoiding things outside our control can undermine true confidence, while accepting and engaging allows us to grow resilient. Accepting the reality of my tinnitus frees me to quit waiting on a cure that may never come and get on with building a new life with noise in my noggin… Accepting reality makes me response-able. Not in control, not out of control. Able to respond. From Think Wild, Mental Growth Tactic 11: Build Real Confidence